Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: LaMPO RCT

OBJECTIVES: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. METHODS: One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. RESULTS: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded. CONCLUSIONS: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain

Collagen-based new bioartificial polymeric materials

Bioartificial polymeric materials, based on blends of biological and synthetic polymers, have been proposed as new materials for applications in the biomedical field. They should usefully combine the biocompatibility of the biological component with the physical and mechanical properties of the synthetic component. Blends of collagen with either poly(vinyl alcohol) or poly(acrylic acid) have been prepared by mixing aqueous solutions of the two polymers. Differential scanning calorimetry and dynamic mechanical thermal analysis has been carried out to investigate the miscibility properties of the polymers and the mechanical behaviour of the blends

Surgical Treatment of Invasive Fungal Infection in Pediatric Oncology

Background and Aims: Invasive fungal disease (IFD) affects primarily patients with a compromised immune system, mainly children with a hematological malignancy. This type of infection is often aggressive and related with high mortality, despite the improvement of medical treatment. New evidences report that the association of medical treatment and surgery may ameliorate the outcome. The aim of this study was to analyze the surgical experience of a single-center in the treatment of fungal infections in the pediatric oncological populations. Methods: Retrospective study (2000 to 2020) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies. We analyzed presentation and diagnosis of IFD, medical treatment, indication for surgery, type of surgical treatment and outcomes including complications (rated according to Clavien Dindo Classification), eventual delay in the resume of the oncological treatment, resolution of infection, relapse and survival. Results: Forty patients (19M, 21F), median age 8 years (0-17) at the diagnosis of IFD. The main indications for surgery were no benefits from medical treatment and advance of fungal infection (67%), the need to confirm the diagnosis (12,5%), and only two patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%), followed by maxillofacial region (17.5%) and the most frequently identified pathogen was Aspergillus (25%). The most common procedures were lobectomy (performed in 16 patients) and lung resection (8). Complications were mostly treated by medical approach. Only in 7 cases mycoses were persistent after surgery. The median time of resumption oncological treatment was 40 days (range 0-150). Reason of death was predominantly related to refractorymalignancy (18). Conclusions: Surgery is a feasible tool in the multimodal treatment of invasive fungal infection in pediatric oncological patients, with excellent resolution rate. Overall mortality depends on the underlying malignancy

Surgical treatment of invasive fungal infection in pediatric oncology

Background: Invasive fungal disease (IFD) is typically aggressive and related with high mortality in children with a hematological malignancy. The association of medical and surgical treatment may ameliorate the outcome. The aim of this study was to analyze the surgical treatment of fungal infections in pediatric oncological populations. Methods: Retrospective study (2000-2022) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies and IFD, analyzing the outcome. Results: From the 70 pediatric cases of hematologic malignancies with the diagnosis IFD over 22 years, we included in the present study 44 cases who required surgical approaches for either diagnosis or treatment. Twenty-one patients were males and the mean age was 11 (range 1-23) years. The main indications for surgery were lack of improvement following medical treatment and/or progression of fungal infection (80%) and diagnosis confirmation (20%). Only five patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%) and the most frequently identified pathogen was Aspergillus (75%). The most common surgical procedures were lobectomy (performed in 17 patients) and atypical lung resection (10). Complications of surgery were mostly treated by medical approach. The mean time of resumption of oncological treatment was 40 (range 0-150) days. Conclusions: Surgery is an important step in the multimodal treatment of invasive fungal infection with excellent resolution rate. Overall mortality depends on the underlying malignancy

Screening for SARS-CoV-2 infection in pediatric oncology patients during the epidemic peak in Italy

Results of a prospective screening for SARS-COV-2 in pediatric patients with hematological and oncological disease

Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: LaMPO RCT

Abstract 1 Objectives To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. 2 Methods One hundred and one children with WHO grade > 2 chemotherapy‐induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0–10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. 3 Results Fifty‐one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0–3] vs. 2.5 [1–5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded. 4 Conclusions PBM is a safe, feasible, and effective treatment for children affected by chemotherapy‐induced OM, as it accelerates mucosal recovery and reduces pain